Some patients with chronic rhinitis show a positive result of the nasal allergen provocation test (NAPT), without systemic IgE sensitization detected by skin prick tests or serum allergen-specific IgE (sIgE) measurement. This condition has come to be called local allergic rhinitis (LAR) and affects children and adults worldwide, although it is underdiagnosed. LAR is not the initial stage of classical allergic rhinitis (AR), but a unique form of chronic rhinitis that is neither classical AR nor non-AR. Many of the features of AR and LAR are similar, such as a positive NAPT, positive tests for type 2 inflammatory markers, including the nasal discharge of sIgE, and a high incidence of asthma. LAR needs to be included in the differential diagnosis of patients with symptoms suggestive of AR in the absence of evidence of systemic atopy, regardless of the age. The diagnosis of LAR relies on positive responses to a single allergen or multiple allergens in the NAPT, the sensitivity, specificity, and reproducibility of which have been demonstrated to be high. The basophil activation test and measurement of IgE in nasal secretions could also aid in the diagnosis of LAR. Treatment for LAR is similar to that for AR and is supported by the efficacy and safety of allergen exposure avoidance, drug therapy, and allergen immunotherapy. This review discusses current knowledge of LAR.

It is important to exclude organic diseases when evaluating patients presenting with pulsatile tinnitus. We report the case of a 69-year-old patient with a transverse-sigmoid sinus dural arteriovenous fistula who presented to us complaining of pulsatile tinnitus in the right ear. Findings of magnetic resonance imaging suggested an intracranial vascular lesion and the diagnosis of dural arteriovenous fistula was confirmed by angiography. The tinnitus resolved after transvenous embolization. There are no signs of recurrence or postoperative complications. Our experience underlines the need to exercise caution during evaluation of a patient with pulsatile tinnitus.

In this study, I selected patients who visited my clinic over the past two years with the first episode of vestibular migraine (VM) and retrospectively reviewed their age at the first visit, gender, the complications they developed, and their transition rate to persistent postural-perceptual dizziness (PPPD).

Eligible subjects were new first-ever cases of VM that visited my clinic during the two-year period from June 1, 2020, to May 31, 2022, who met the diagnostic criteria for VM established by the Barany Society (revised 2012).

There were a total of 147 cases, of which 23 cases were men and 124 were women, representing a male-to-female ratio of 1:5.4; thus, the patients were predominantly female. The mean age ± standard deviation was 34.7 ± 17.4 years; when classified by gender, the men ranged in age from 12 to 68 years old (mean age, 23.7 ± 13.2 years), while the women ranged in age from 10 to 77 years old (mean age, 36.7 ± 17.3 years); thus, the women were comparatively older.

The period from the initial episode to the initial consultation was 3 days in 43 cases, within 7 days in 28 cases, within 14 days in 12 cases, within 21 days in 5 cases, within 28 in 23 case, and 29 days or longer in 36 cases, indicating that at 56.4% of the patients sought a diagnosis within 14 days.

The most common months for the initial consultation were June to July and September to October.

As for the time to remission, remission occurred in less than 2 months in 28 cases, in less than 3 months in 17 cases, and in 3 months or longer in 77 cases; the status of the remaining 25 patients who stopped visiting the clinic is unknown.

There were 4 cases that transitioned from VM to PPPD and 1 case that transitioned from VM with Ménière’s disease (MD) to PPPD.

The transition rate from VM alone to PPPD was 2.7％, while the rate increased to 3.4% when case of VM with MD transitioning to PPPD were also included. After excluding cases whose status was unknown, the transition rate from VM to PPPD was 3.3％, with the rate increasing to 4.1% when cases of VM with MD that transitioned to PPPD were also included.

As compared with the transition rate of definite case of benign paroxysmal positional vertigo (BPPV) to PPPD that was investigated previously, the transition rate from VM to PPPD was higher.

A minimally invasive and effective technique to close perforated tympanic membranes that do not heal spontaneously has been developed recently. The bFGF preparation, Retympa^®, which began to be covered by Japanese national insurance in 2019, is a scaffold material that facilitates tympanic membrane regeneration. Retympa^® is impregnated in a bioabsorbable material (gelatin sponge) and inserted into the tympanic membrane defect and fixed with bioadhesive glue (fibrin glue). In the present study, we report a case of tympanic membrane perforation after cochlear implantation (CI) surgery that was treated by insertion of Retympa^®. The patient was a 73-year-old man with chronic otitis media on the left side and bilateral sensorineural hearing loss. Although the tympanic membrane perforation closed spontaneously before the CI surgery, it recurred after the surgery, and failed to close completely even with the application of a Beschitin dressing. Thereafter, 3 months after the surgery, Retympa^® was inserted, which resulted in complete closure of the left tympanic membrane perforation. No postoperative otitis media or tympanitis was observed, and there was no worsening of the speech intelligibility test results or CI stimulation current values at 3, 6, and 12 months after the CI surgery. Otitis media after CI surgery may become intractable due to foreign body reaction, and closure of the tympanic membrane is necessary to prevent the development of this complication. Retympa^® insertion is a safe treatment method for closure of tympanic membrane perforation after CI surgery and the possibility of contact with electrodes is low, and the softness and easily degradability of gelatin sponge make it safe. Based on the present case, we suggest that Retympa^® insertion is a safe and effective technique for closure of tympanic membrane perforation after CI surgery.

Melanotic oncocytic metaplasia (MOM) is a relatively rare non-neoplastic disease characterized by slight pigmentation around the Eustachian tube. MOM is relatively more common in smokers and Asian men in their 60s and 70s. Herein, we report a case of MOM of the nasopharynx that was detected incidentally while the patient was being examined for a parotid tumor. Biopsy of a pigmented lesion located in the nasopharynx was performed. Immunohistochemistry revealed positive staining of the oncocytic cells for S-100, SOX-10, and Melan A, and negative staining for HMB-45, which led us to make a final diagnosis of MOM. Moreover, we also conducted a review of the literature on MOM. In patients presenting with a pigmented lesion in the nasopharynx, it is important to bear in mind the possibility of MOM of the nasopharynx and also to differentiate the condition from mucosal malignant melanoma.

Acute sinusitis is known to be associated with a high risk of severe complications due to the spread of infection into the cranial cavity and orbits, and these complications appear to occur more commonly in children. Herein, we report two pediatric cases of acute rhinosinusitis with intracranial and orbital complications. Case 1: A 13-year-old girl presented with the complaints of headache, neck pain, and nausea. Imaging studies revealed evidence of sphenoid sinusitis, and the patient was referred to our hospital as a case of meningitis complicating sphenoid sinusitis. She also had palsy of the right abducens nerve. We performed emergency endoscopic sinus surgery (ESS) and continued the antibiotic therapy. Her symptoms improved promptly and she was discharged from the hospital without any sequelae. Case 2: A 11-year-old girl who presented with left eyelid swelling and high fever was referred to us with a diagnosis of orbital subperiosteal abscess and orbital cellulitis caused by frontal sinusitis. We performed emergency ESS on the day of admission, but as the left orbital subperiosteal abscess worsened, puncture drainage was also performed on the 3^rd postoperative day. Thereafter, the patient’s symptoms promptly improved.

Intracranial and orbital complications of acute rhinosinusitis may sometimes have severe sequelae or even a fatal outcome. Therefore, clinicians must have a high index of suspicion, make an early diagnosis, and provide prompt and aggressive multidisciplinary treatment for these complications to prevent unfortunate outcomes.

We report a case of facial skin cancer in whom we performed lip reconstruction using an Estlander flap. A 44-year-old man presented to us with a large slowly growing skin tumor with a maximum diameter of 80 mm extending from the right cheek to the mandible. In addition to infiltrating the buccal mucosa, it also formed an approximately 15‑mm induration under the mucosa of the lower lip. We diagnosed the patient as having squamous cell carcinoma of the skin, cT2N0M0 Stage II, and performed primary resection of the skin tumor with right neck dissection, along with facial and oral cavity reconstruction using a pectoralis major myocutaneous flap and lower lip reconstruction using an Estlander flap. No recurrence has been noted in the head and neck region during the 3-year follow-up period since the surgery, and the patient is able to take regular diet orally. In this case, since the resection range was 1/2 of the width of the lower lip, we selected the Estlander flap and were able to preserve the postoperative lip function. In lip reconstruction surgery, it is important to maintain not only the esthetics, but also the lip function. Therefore, it is desirable to select a reconstruction method that is tailored to the resection width and site.

Pyriform sinus fistula is a rare brachial pouch anomaly that can result in acute suppurative thyroiditis and neck abscess. As radical treatment, fistulectomy through an external neck incision has been performed. Recently, however, the transoral electrocauterization has been reported as a less invasive treatment for pyriform sinus fistula. We attempted electrocauterization of the internal opening of the fistula tract under a microscope. The postoperative course of the patient was satisfactory, and no recurrence was observed for at least six months. It is suggested that transoral electrocauterization could be a reasonable treatment approach for pyriform sinus fistula.

Granular cell tumors are soft tissue tumors that are rarely occur in the hypopharynx. Herein, we report two cases of granular cell tumors of the hypopharynx. The first patient was a 52-year-old woman. The hypopharyngeal tumor was detected by screening CT examination. Endoscopic examination revealed a highly mobile tumor in the left hypopharyngeal pyriform sinus, and laryngomicrosurgery was performed to remove the tumor. Histopathological examination showed sheet-like growth of acidophilic tumor cells, and immunohistochemistry showed positive tumor cell staining for S-100 protein. Based on the findings, the tumor was diagnosed as a granular cell tumor. The MIB-1 index was less than 5%, and the excision margin was negative. Until six months after the surgery, there was no obvious recurrence or metastasis.

The second patient was a 45-year-old man. Endoscopic examination revealed a tumor with good mobility in the postcricoid area, and laryngomicrosurgery was performed to remove the tumor. Histopathologically, the tumor cells contained highly acidophilic granules, and immunohistochemistry showed positive staining of the tumor cells for S-100 protein and vimentin. Based on the findings, the tumor was diagnosed as a granular cell tumor. Until 18 months after the surgery, there was no recurrence or metastasis. It should be noted that granular cell tumors may recur even if they are histopathologically benign, and long-term follow-up of the patients is necessary.

Since the 1980s, there have been some reports of infection with hypervirulent Klebsiella pneumoniae (hvKp), an invasive Klebsiella infection, from Southeast Asia and East Asia, in patients with liver abscess, multiple abscesses, endophthalmitis, and meningitis.

Herein, we report two patients with hvKp infection in the head and neck region who were hospitalized at our department.

Case 1 was a 58-year-old man with a history of diabetes mellitus and liver cirrhosis. He presented to our internal medicine outpatient department with the chief complaints of fever and neck swelling. As computed tomography (CT) showed a neck abscess, he was referred to our department. We immediately performed incision and drainage, and debridement for necrotizing fasciitis. Blood culture yielded negative results, while pus cultures grew string test-positive Klebsiella pneumoniae. Based on the results and clinical course, we diagnosed the patient as having hvKp infection. We started the patient on antimicrobial treatment with ampicillin-sulbactam and de-escalated to cefazolin. We also performed further debridement and tracheotomy, and discharged the patient on day 38 after admission.

Case 2 was an 85-year-old man with a history of chronic heart failure. He was rushed to our hospital emergency with acute epiglottitis, and we performed emergent tracheotomy. At night, a vasopressor was initiated for the treatment of shock. CT showed findings suggestive of abscess formation in the esophagus wall. On day 2 of admission, he developed cardiac arrest, but was temporarily resuscitated; however, on day 3, he developed cardiac arrest again, and died. We diagnosed the patient as having hvKp infection based on the results of blood cultures and genetic tests. HvKp is a highly pathogenic infection that causes formation of abscesses and metastatic foci of infection. After identifying the hvKp strain, it is important to promptly perform systemic evaluation and provide multimodal therapy, including surgery and antibiotic therapy.

We conducted a clinical study of 35 patients (42 ears) with acute acoustic hearing disorder who visited the otolaryngology department of Himeji St. Mary’s Hospital over the 12-year period from January 2012 to December 2023. The patients ranged in age from 16 to 81 years, with an average of 34.7 years (median age, 27 years); there were 27 male and 8 female patients. The disease was caused by exposure to shooting sounds in 22 cases (“shooting sounds” group) and exposure to other strong and loud sounds in the remaining 13 cases (“other sounds” group). The mean age was significantly lower and the interval from onset of symptoms to consultation was shorter in the “shooting sounds” group than in the “other sounds” group. As for the types of audiogram, the c⁵-dip type was the most common (11 ears), followed in frequency by the gradually down-sloping, sharply down-sloping, and flat type. The overall hearing improvement was as follows: complete healing, 40.5%; marked recovery, 11.9%; recovery, 19.0%; and unchanged, 28.6%. The degree of hearing improvement classified by the types of audiogram was good for all of the c⁵-dip, dip (2K), and V-shaped types. Patients under 30 years of age, with a short interval from the onset to start of treatment, and with bilateral hearing loss showed good hearing improvement. There was a tendency for the degree of hearing improvement to be better in the “shooting sounds” group than in the “other sounds” group.